Public-Private Mix

Draft Charter on Private and Public Health Care in South Africa
Critical Health Perspectives

The Department of Health’s recently released Draft Charter of the Public and Private Health Sectors (CPPHS) aims to address the legacy of apartheid restraint on access to health care for all South Africans. It commits public and private sectors to create “a health care system that is coherent, cost-effective and quality driven … for the benefit of the entire population” and to work together “to improve the scope, accessibility and quality of care at all levels”. For these laudable goals we give our wholehearted support. The CPPHS specifies four “key areas” of transformation: access to health services, equity in health services, quality of health services, and Black Economic Empowerment (BEE). The first three – access to, equity in, and quality of health care services, are essential (though not enough) to meet the goal of health for all South Africans. The fourth area is problematic.

Further details: /newsletter/id/31148
Drug development for neglected diseases: a deficient market and a public-health policy failure

There is a lack of effective, safe, and affordable pharmaceuticals to control infectious diseases that cause high mortality and morbidity among poor people in the developing world. This article from The Lancet analyses the outcomes of pharmaceutical research and development over the past 25 years, and reviews current public and private initiatives aimed at correcting the imbalance in research and development that leaves diseases that occur predominantly in the developing world largely unaddressed. It found that of 1393 new chemical entities marketed between 1975 and 1999, only 16 were for tropical diseases and tuberculosis. The article concludes that private-sector research obligations should be explored, and a public-sector not-for-profit research and development capacity promoted.

DSA Annual Conference 11 November 2006: The private sector, poverty reduction and international development
Development Studies Association

The Development Studies Association (DSA) one-day conference titled The Private Sector, Poverty Reduction and International Development will take place on November 11th 2006 at the University of Reading. Health-related topics under one of three main conference themes "Business and Finance and Poverty Reduction" include "HIV and Aids: Technical and policy issues for the private sector" and "Government attitudes to the private sector as an engine of growth: policy issues and debate".

Effect of an expansion in private sector provision of contraceptive supplies on horizontal inequity in modern contraceptive use: evidence from Africa and Asia
Hotchkiss DR, Godha D and Do M: International Journal for Equity in Health 10(33), 19 August 2011

The study is based on multiple rounds of Demographic and Health Survey data from four selected countries (Nigeria, Uganda, Bangladesh, and Indonesia) in which there was an increase in the private sector supply of contraceptives. The methodology involves estimating concentration indices to assess the degree of inequality and inequity in contraceptive use by wealth groups across time. The results suggest that the expansion of the private commercial sector supply of contraceptives in the four study countries did not lead to increased inequity in the use of modern contraceptives. In Nigeria and Uganda, inequity actually decreased over time; while in Bangladesh and Indonesia, inequity fluctuated. The study results do not offer support to the hypothesis that the increased role of the private commercial sector in the supply of contraceptive supplies led to increased inequity in modern contraceptive use.

Engaging the private sector for tuberculosis control: much advocacy on a meagre evidence base
Mahendradhata Y, Lambert M-L, Boelaert M, Van der Stuyft P: Tropical Medicine & International Health 12(3): 315-316, March 2007

Advocacy on engaging the private sector in tuberculosis (TB) control is mounting. In the newly launched six-point Stop TB Strategy, WHO makes an urgent appeal to engage private care providers. Even more recently, this was supplanted by a guide on how to involve all care providers in TB control through different Public-Private Mix (PPM) approaches. At the same time the body of evidence on the effectiveness of such approaches, although growing, remains rather weak.

Europe’s contribution to anti-corruption efforts in Sub-Saharan Africa
Kaninda JT and Schepers S: European Policy Centre Policy Brief, March 2010

This article outlines the measures that European Union (EU) and African countries are planning through the economic partnership agreements to address public and private corruption, including non-compliance with promised off-sets in public contracts, in both African and EU governments and companies. Corruption is argued to distort fair competition, as companies gain competitive advantages and increase profitability and share value through illegal and unethical behaviour, while those companies that choose to be responsible find themselves at a disadvantage. Africa is argued to be no more corrupt than any other region, with alleged costs to African economies of US$148 bn per year, according to estimates by the Commission of the African Union. Corruption is argued to be responsible for losses of up to 50% of countries’ tax revenue, in many cases more than foreign debt.

Expensive private healthcare highlighted at inquiry
Mashego P: BDLive, February 2016

The high cost of private health care in South Africa was profiled in a February 2016 health market inquiry amid revelations that South Africans pay six times the international average for hospital stays. A World Health Organisation study on price levels for private hospitals found that 42% of the funds spent on private voluntary health insurance in South Africa were equivalent to 4% of the country’s gross domestic product. This is six times the average in the Organisation for Economic Cooperation and Development (OECD) countries, despite the expenditure in SA only covering 17% of the population. The report found that South Africans stayed in hospitals for an average of 3.9 days compared to 5.1 days in OECD countries and paid an estimated R20bn in out-of-pocket payments for healthcare. Speaking on the sidelines of the inquiry, Health Minister Aaron Motsoaledi said that healthcare prices were "exorbitant" and that needed to change.

Experimental vaccine to be used against Ebola outbreak in the DRC
Branswell H: Stat, 2018

A campaign to vaccinate people at risk of developing Ebola in the latest outbreak in the Democratic Republic of the Congo began in May 2018. The government of the DRC has formally asked to use an experimental vaccine being developed by Merck. The WHO has a stockpile of 4,300 doses of the vaccine in Geneva and the company has 300,000 doses of the vaccine stockpiled in the United States. Merck has given its permission for the vaccine to be used in this outbreak. As the vaccine — provisionally called V920 — is not yet licensed, the government deployed it under a compassionate use protocol. At this stage, it can only be used in the context of a clinical trial, plans for which are already in the works. The WHO director-general noted that DRC has lots of experiencing combating Ebola, since the first known outbreak in 1976 happened there. The 2018 outbreak marks the ninth known time Ebola has broken out in the DRC.

Exploring new health markets: experiences from informal providers of transport for maternal health services in Eastern Uganda
Pariyo G: BMC International Health and Human Rights 11(Suppl 1): S10, August 2011

The author of this paper examined the functioning of the informal transport markets in facilitating access to maternal health care in Eastern Uganda, to demonstrate the role that higher institutions of learning can play in designing projects that can increase the utilisation of maternal health services. Data were collected through qualitative and quantitative methods that included focus group interviews and a review of project documents and facility-level data. There was a marked increase in attendance of antenatal, and delivery care services, with the contracted transporters playing a leading role in mobilising mothers to attend services, the authors found. The project also had economic spill-over effects to the transport providers, their families and community generally. However, some challenges were faced including difficulty in setting prices for paying transporters, and poor enforcement of existing traffic regulations. The findings indicate that locally existing resources such as motorcycle riders can be used innovatively to reduce challenges caused by geographical inaccessibility and a poor transport network with resultant increases in the utilisation of maternal health services. However, care must be taken to mobilise the resources needed and to ensure that there is enforcement of laws that will ensure the safety of clients and the transport providers themselves.

Faith-based health services as an alternative to privatization? A Ugandan case study
Dambisya YM, Manenzhe M, Kibwika-Muyinda A: Municipal Services Project Occasional Paper July 2014

This study examines the delivery of health services by faith-based organizations (FBOs) as a possible alternative to privatization in Uganda, where they have been servicing communities since the mid-19th century. Their facilities focus on primary care and operate in rural, under-serviced areas where they provide access to care without discrimination on the basis of religion or ethnic group, charging affordable user fees while also treating those who cannot pay. The sector presently contributes to more than a quarter of all health services in the country, including the training of health professionals. Based on literature reviews and more than 30 key informant interviews, this research finds that FBOs promote solidarity through multi-stakeholder engagement and through cross-subsidization using mechanisms such as community health financing schemes that protect patients from catastrophic health expenditure. It analyzes how this ‘private not-for-profit’ sector fosters the development of a strong quasi-public ethos in service delivery, especially at the primary level of the Ugandan health system, posing a challenge to western liberal ideas about how the state and religion interface.